Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. (...) The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

The pragmatic inquiry process used in the Corporantes Pathfinder Notebook (CPN) enables students and others to discern their gifts, find purpose and direction in their lives, and seek a FIT between their values and various corporate cultures before making extensive commitments in their field of studies and their employment. Based on Peirce''s theory of Pragmatism the CPN fosters investigation, interpretation, and action resulting from reflected narratives written in response to a series of questions in the CPN. The CPN was used (...) successfully as a framework in a Business Ethics course for connecting career decisions to their personal lives. Other pedagogic activities were used such as case studies, role playing, service learning, team projects investigating ethical climates of corporations, as well as Socratic questioning and discussions of moral dilemmas to develop ethical sensitivity and understanding of ethical challenges and decisions. The CPN also has been used successfully by senior executives in over fifty applications. (shrink)

This important and comprehensive work of 18th-century Islamic religious thought written in Arabic by a pre-eminent South Asian scholar provides an extensive and detailed picture of Muslim theology and interpretive strategies on the eve of the modern period.

Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children’s position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity (...) is discussed, followed by an examination of Vygostky’s contextualist view on children’s development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults’ decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties. (shrink)

Believing that p, assuming that p, and imagining that p involve regarding p as true—or, as we shall call it, accepting p. What distinguishes belief from the other modes of acceptance? We claim that conceiving of an attitude as a belief, rather than an assumption or an instance of imagining, entails conceiving of it as an acceptance that is regulated for truth, while also applying to it the standard of being correct if and only if it is true. We argue (...) that the second half of this claim, according to which the concept of belief includes a standard of correctness, is required to explain the fact that the deliberative question whether to believe that p is transparent to the question whether p. This argument raises various questions. Is there such a thing as deliberating whether to believe? Is the transparency of the deliberative question whether to believe that p the same as the transparency of the factual question whether I do believe that p? We will begin by answering these questions and then turn to a series of possible objections to our argument. (shrink)

Why, when asking oneself whether to believe that p, must one immediately recognize that this question is settled by, and only by, answering the question whether p is true? Truth is not an optional end for first-personal doxastic deliberation, providing an instrumental or extrinsic reason that an agent may take or leave at will. Otherwise there would be an inferential step between discovering the truth with respect to p and determining whether to believe that p, involving a bridge premise that (...) it is good (in whichever sense of good one likes, moral, prudential, aesthetic, allthings-considered, etc.) to believe the truth with respect to p. But there is no such gap between the two questions within the first-personal deliberative perspective; the question whether to believe that p seems to collapse into the question whether p is true. (shrink)

تشخيص فكري ومعرفي لمفهوم الأسرة ومكانتها في الفكر الإسلامي، وتفحّصٌ علمي ومنهجي لأسس البناء الأسري ومقاصده، وكشفٌ عن تأثير التحوّلات الاجتماعية في الأسرة والتحديات التي تواجهها، وتتبعٌ لانعكاسات الفكر الغربي في المنظومة القيمية للأسرة، وتبيّنٌ لبعض التجارب والخبرات في مجال المحافظة على دور الأسرة، لا سيما بعد هيمنة النموذج المعرفي الغربي، ومحاولة طمسه للخصوصيات الثقافية والمجتمعية. حاولت بحوث هذا الكتاب أن تجيب عن تساؤلات معرفية ومجتمعية مهمة مثل: ما أهم التحديات التي تواجه الأسرة المسلمة في الراهن المعاصر وكيفية مواجهتها، وما (...) التغيرات التي طرأت على الأسرة المسلمة في ظل التطورات والتسارعات المجتمعية والاقتصادية والتقنية إلخ، وما التصوّر الإسلامي لدور الأسرة في بناء المجتمع، وما دور مؤسسات المجتمع المدني في الحد من تأثير الاستلاب الثقافي، وما الإسهام الذي قدمته حركات الإصلاح الإسلامية في مجال المحافظة على الدور المحوري للأسرة في تشكيل الشخصية الإسلامية القادرة على تفعيل النهوض الحضاري؟ وقد أسهم المشاركون في هذا العمل الجماعي، الذين بلغ عددهم واحداً وعشرين باحثاً، في محاورة هذه الأسئلة المعرفية، وفي التأسيس لمنظومة معرفية مجتمعية قادرة على الإسهام في البناء الحضاري، وفي توجيه دفة الأسرة بما ينسجم مع التوجيهات الربانية والفطرة الإنسانية. (shrink)

Background: Pediatric guidelines recommend that children and adolescents participate in a developmentally appropriate way in end-of-life decision making. Shared decision making in pediatrics is unique because of the triadic relationship of patient, parents, and physician. The involvement of the patient may vary on a continuum from no involvement to being the sole decision maker. However, the effects of child participation have not been thoroughly studied. The aims of this literature review are to identify studies on end-of-life decision making in pediatrics, (...) to explore patient participation, and to assess the effects of such participation. Methods: Five databases—PubMed, PsycInfo, Medline, CINAHL, and Sociological Abstract—were searched for empirical studies on end-of-life decision making in pediatrics. Selected articles fulfilling the criteria were assessed for type of decision, participants’ characteristics, reports on participation of the minor patient, and outcome. Results: Fifty-seven articles on end-of-life decision making in pediatrics were identified. The majority of papers (n = 43, 75%) investigated parents’ and clinicians’ perspectives, while only 14 articles (25%) included perspectives of children and adolescents. Twenty-two articles (39%) reported some details on various forms of children's participation (e.g., receive information, plan care details, consulted before or after a decision was made). Positive (e.g., respect for patient's preferences) and negative (e.g., conflict due to diverging opinions) effects of children's participation in end-of-life decision making were reported. Conclusions: This systematic review highlights the need for research to identify factors that contribute to a favorable participation of minors in decision-making processes, as well as strategies to solve possible conflicts. More research should take into account the dynamics in the triadic process of decision making and emphasize children and adolescents’ perspectives. A better understanding of how to meaningfully involve children and adolescents in end-of-life decision making could facilitate the practice of patient participation in pediatrics. (shrink)

When we deliberate whether to believe some proposition, we feel immediately compelled to look for evidence of its truth. Philosophers have labelled this feature of doxastic deliberation 'transparency'. I argue that resolving the disagreement in the ethics of belief between evidentialists and pragmatists turns on the correct explanation of transparency. My hypothesis is that it reflects a conceptual truth about belief: a belief that p is correct if and only if p. This normative truth entails that only evidence can be (...) a reason for belief. Although evidentialism does not follow directly from the mere psychological truth that we cannot believe for non-evidential reasons, it does follow directly from the normative conceptual truth about belief which explains why we cannot do so. (shrink)

Brain death, or the determination of death by neurological criteria, has been described as a legal fiction. Legal fictions are devices by which the law treats two analogous things (in this case, biological death and brain death) in the same way so that the law developed for one can also cover the other. Some scholars argue that brain death should be understood as a fiction for two reasons: the way brain death is determined does not actually satisfy legal criteria requiring (...) the permanent cessation of all brain function, and brain death is not consistent with the biological conception of death as involving the irreversible cessation of the functioning of an organism as a whole. Critics counter that the idea that brain death is a legal fiction is deceptive and undemocratic. I will argue that diagnosing brain death as a hidden legal fiction is a helpful way to understand its historical development and current status. For the legal‐fictions approach to be ethically justifiable, however, the fact that brain death is a legal fiction not aligned with the standard biological conception of death must be acknowledged and made transparent. (shrink)

The aim of this study is to explore the representation of Pashtuns in Pashtu classic (before 1985) and modern (after 2000) movies and what is the difference of the portrayal of these movies and Pashtun literature. In particular, this study investigated in which time frame the depiction of Pashtun is positive and similar to their academic descriptions. A mixed methods approach consisting of qualitative case study, content analysis and comparative semiotic analysis was used to examine the content of the movies. (...) Eighty positive leading characters were purposely selected from the sample (ten classic and ten modern Pashtu movies) to compare with academic literature on Pashtun culture. (shrink)

Why can't deliberation conclude in an intention except by considering whether to perform the intended action? I argue that the answer to this question entails that reasons for intention are determined by reasons for action. Understanding this feature of practical deliberation thus allows us to solve the toxin puzzle.

Ethical consumerism has been dramatically increasing in recent decades, but in service sector, fewer research has been conducted especially in the fast-food industry. In this paper, we determined empirically the consumer perceived ethicality effects on repurchase intentions as well as on word of mouth through brand image partial mediation and customer expertise moderation in fast-food sector. The data were collected from 307 consumers of the fast-food restaurants through self-administered questionnaires. Common method variance and social desirability bias were measured before testing (...) hypotheses, and the data were investigated by SPSS and AMOS 21st version. The empirical results demonstrated that consumer perceived ethicality effects on repurchase intentions directly and through brand image partial mediation indirectly. Moreover, the direct and positive effects of repurchase intentions on word of mouth were experienced. This study generalized the results of previous studies of consumer perceived ethicality conducted in western culture in Pakistani fast-food sector. This study also proposed that firms should tackle ethical concerns at corporate and operational strategy levels to improve consumers’ behavioral intentions. (shrink)

It is common for philosophers to claim that doxastic voluntarism, the view that an agent can form beliefs voluntarily, is false, and therefore that agents do not have the kind of control over their beliefs required for a straightforward application of deontological concepts such as obligation or duty in the domain of epistemology. The role that the denial of doxastic voluntarism plays in an argument to the effect that agents do not have obligations with respect to belief is simply this.

Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. Traditionally, death was understood to occur when a person stops breathing, their heart stops beating and they are cold to the touch. Today, physicians determine death by relying on a diagnosis of ‘total brain failure’ or by waiting a short while after circulation stops. Evidence has emerged, however, that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from (...) the established biological conception of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethically legitimate but need to be reconciled with the law. The considerable debate over the determination of death in the medical and scientific literature has not informed the public that vital organs are being procured from still-living donors and it seems unlikely that this information can remain hidden for long. Given the instability of the status quo and the difficulty of making the substantial legal changes required by complete transparency, we argue for a second-best policy solution: acknowledging the legal fictions involved in determining death to move in the direction of greater transparency. This may someday result in more substantial legal change to directly confront the challenges raised by life-sustaining and life-preserving technologies without the need for fictions. (shrink)

Mark Schroeder has recently presented apparent counterexamples to the standard account of the distinction between the right and the wrong kinds of reasons. We argue that these examples appear to refute the standard account only because they blur the distinction between two kinds of reasoning: reasoning about whether to intend or believe that p and reasoning about whether to take up the question of whether to intend or believe that p.

Clinical research with children generates special ethical concern, raising the need for additional protections beyond those for research with competent adults. Most guidelines permit research with children when it offers a prospect of direct benefit, or poses minimal risk. Unlike many other guidelines, the U.S. federal regulations also allow institutional review boards to approve pediatric research that does not offer a prospect of direct benefit when the risks are no greater than a minor increase over minimal risk. To approve research (...) in this category, IRBs must find that two additional conditions obtain:1). The intervention or procedure presents experiences to subjects that are reasonably commensurate with those inherent in their actual or expected medical, dental, psychological, social, or educational situations; and 2). The intervention or procedure is likely to yield generalizable knowledge about the subjects disorder or condition which is of vital importance for the understanding or amelioration of the subjects disorder or condition. (shrink)

Mahatma Gandhi, one of the greatest global icons of all times, is known as much for his successful leadership of India’s non-violent anti-colonial freedom movement as for his virtue and simplicity. His ideals have inspired diverse social and political movements across the world: _against _apartheid in South Africa, racial segregation in the United States, several state policies and actions in India and nuclear weaponisation, and _for _environmental sustainability and world peace. Hence, a pertinent question is often raised by media and (...) academia: How would Gandhi have responded to the contemporary Indian and global situation marked by ethnic conflicts, terrorism, economic insecurity under the dominance of a global neo-liberal economic order and moral degeneration in private and public lives? Addressing this question in this volume through critical and variant re-readings of _Hind Swaraj_, his key manifesto of socio-political transformation, social scientists, political philosophers and social activists seek to establish a social and academic dialogue with Gandhi, interrogating his thoughts, values and vision, and examining their relevance to present-day problems. In spotlight is a contentious issue: the relationship between modernity and emancipation of subalterns, in the light of his critique of modern civilisation, the central thesis of the text. This book will be of interest to those in Gandhian studies, political science, history, philosophy, sociology, development studies, as well as activists, policy makers and the lay reader. (shrink)

In the United States and Europe, an increasing emphasis on equality has pitted rights claims against each other, raising profound philosophical, moral, legal, and political questions about the meaning and reach of religious liberty. Nowhere has this conflict been more salient than in the debate between claims of religious freedom, on one hand, and equal rights claims made on the behalf of members of the lesbian, gay, bisexual, and transgender community, on the other. As new rights for LGBT individuals have (...) expanded in liberal democracies across the West, longstanding rights of religious freedom -- such as the rights of religious communities to adhere to their fundamental teachings, including protecting the rights of conscience; the rights of parents to impart their religious beliefs to their children; and the liberty to advance religiously-based moral arguments as a rationale for laws -- have suffered a corresponding decline. Timothy Samuel Shah, Thomas F. Farr, and Jack Friedman's volume, Religious Freedom and Gay Rights brings together some of the world's leading thinkers on religion, morality, politics, and law to analyze the emerging tensions between religious freedom and gay rights in three key geographic regions: the United States, the United Kingdom, and continental Europe. What implications will expanding regimes of equality rights for LGBT individuals have on religious freedom in these regions? What are the legal and moral frameworks that govern tensions between gay rights and religious freedom? How are these tensions illustrated in particular legal, political, and policy controversies? And what is the proper way to balance new claims of equality against existing claims for freedom of religious groups and individuals? Religious Freedom and Gay Rights offers several explorations of these questions. (shrink)

Transcriptional silencing may not necessarily depend on the continuous residence of a sequence‐specific repressor at a control element and may act via a “hit and run” mechanism. Due to limitations in assays that detect transcription factor (TF) binding, such as chromatin immunoprecipitation followed by high‐throughput sequencing (ChIP‐seq), this phenomenon may be challenging to detect and therefore its prevalence may be underappreciated. To explore this possibility, erythroid gene promoters that are regulated directly by GATA1 in an inducible system are analyzed. It (...) is found that many regulated genes are bound immediately after induction of GATA1 but the residency of GATA1 decreases over time, particularly at repressed genes. Furthermore, it is shown that the repressive mark H3K27me3 is seldom associated with bound repressors, whereas, in contrast, the active (H3K4me3) histone mark is overwhelmingly associated with TF binding. It is hypothesized that during cellular differentiation and development, certain genes are silenced by repressive TFs that subsequently vacate the region. Catching such repressor TFs in the act of silencing via assays such as ChIP‐seq is thus a temporally challenging prospect. The use of inducible systems, epitope tags, and alternative techniques may provide opportunities for detecting elusive “hit and run” transcriptional silencing. Also see the video abstract here https://youtu.be/vgrsoP_HF3g. (shrink)

Based on the social exchange theory, the aim of this study is to identify the association between job stress state anger, emotional exhaustion and job turnover intention. This study postulates that job related stress and state anger among nurses during COVID-19 subsequently leads to their job turnover intentions. In addition, the study also aims to see the mediating role of emotional exhaustion between COVID-19-related job stress, state anger, and turnover intentions. The sample of this study is gathered from 335 registered (...) nurses working in Pakistani hospitals dealing with COVID-19-related patients. The interrelationships between variables are checked by using structural equation modeling through AMOS. Key findings confirm that COVID-19-related job stress and state anger had a significant effect on nurses’ turnover intentions. Furthermore, emotional exhaustion mediated the relationship between COVID-19-related job stress, state anger, and turnover intentions. There is a lack of research which has assessed the impact of Novel COVID-19-related job stress and state anger on nurses’ turnover intentions in hospitals, providing empirical evidence from a developing country-Pakistan. This study offers managerial implications for hospital management and health policymakers. Moreover, nursing managers need to pay attention to nurses’ turnover intentions who are facing the issue at the front line as patients receive their initial treatment from nurses in the COVID-19 outbreak. (shrink)